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ELDER CARE: Caring for California's Aging Population : Money Problems Must Be Faced--No Matter How Tough


There are two persistent--and mistaken--myths about old age. The first is that families abandon the elderly. The second is that Medicare pays for everything the elderly need.

"Fiscal constipation is a malady that afflicts many elderly persons--and with good reason: Getting old can be a very expensive proposition," said Mary Lou Parks, a former nurse who directs Senior Care Consultants Inc., a firm that provides assistance for frail seniors and their families in Ventura County and parts of Los Angeles County.

As the difficulties of aging can put tremendous strains on family relationships, the maladies of old age can also stretch family pocketbooks to their limits--and beyond.

"One of the reasons is that most of one's medical expenses occur in the last years of life, the time that most people have the least income," said Leah Buturain, who has been a staff aide on both House and Senate committees on aging in Washington.

"As everyone knows," she added, "medical expenses can run fairly high today."

What happens when chronic illness wipes out an elderly person's savings? Who is eligible for government assistance? How do low-income Americans finance their old age? Where do house-rich but cash-poor people go for help?

These are questions that plague almost all elderly Americans, but they are ones that few families are eager to discuss. Some of the reluctance is a matter of pride, a basic aversion to letting anyone outside the family know how serious problems at home really are. And part of the reticence stems from fear, a fundamental dread of what the future holds.

Frances B. Schloss, a vice president of Shearson Lehman Hutton Inc., learned the hard way that, for many elderly people, some subjects are simply taboo.

A veteran of the personal finance business, Schloss was asked recently to give a talk at the Freda Mohr Multipurpose Senior Services Program, which services a largely middle-class Jewish clientele in the Fairfax District of Los Angeles.

Schloss chose for her topic long-term health insurance, one of the newest insurance products on the market. For a monthly premium, people between the ages of 50 and 79 can get insurance to cover the costs of living in a licensed nursing home, should chronic illness or disability require long-term, round-the-clock care or supervision.

"One way to think about this kind of policy is that it is like fire insurance," Schloss told her audience. "It is something you have for protection, but you hope you never have to collect a dime from it."

The two dozen or so men and women at the senior citizens' center would have none of it. After innumerable interruptions, Schloss was abruptly told to end her talk.

"This is something I simply do not want to think about," muttered one elderly woman in the audience. "I suspect a lot of people feel that way."

In fact, experts say, planning for long-term care in old age is something most people should think about.

The vast majority of Americans will never make use of a nursing home, but there is no predicting who will be lucky and who won't.

For those who become so frail or chronically ill that they have to be permanently institutionalized, the costs can be prohibitively high. On the low end, a nursing home runs about $50 a day in Texas. On the high end, costs can climb to more than $100 a day in California.

Even for those fortunate enough--or determined enough--to continue living on their own, there can be a cascade of practical problems in getting through even an ordinary day. The person who cannot drive still needs to go to the doctor. The person who cannot get in and out of the bathtub still needs to bathe. The person who cannot lift heavy packages still needs to buy groceries. The person who cannot hear still has to maintain contact with the world.

Unless an elderly person has a servant or a relative who is willing to act as full-time chauffeur, bather, packer, shopper, cook and telephone operator, someone will have to found--and probably paid--to take on these responsibilities.

Senior citizens' centers, hospitals, city and county agencies and private care managers can offer referrals to nursing registries and homemaker agencies. But the help that is available can be unreliable. Home-care workers in Los Angeles, as in many large cities, are overwhelmingly female and immigrants; many are working illegally in this country and supporting families of their own.

For the families who hire them, the cost of home-care workers' services is often high--from $4 to more than $20 an hour. For workers, however, such wages are not necessarily attractive, particularly if employers are difficult, hours are long or irregular and pensions and medical benefits are nonexistent, as is often the case.

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